Hydroxychloroquine and Chloroquine Induced Cardiomyopathy: A Concise Review

Pramod Theetha Kariyanna; Andrew Doodnauth; Mrinali Shetty; Benjamin Ramalanjaona; Naseem Hossain; Yuvraj Singh Chowdhury; Nimrah Hossain; Apoorva Jayarangaiah; Adam Budzikowski

doi:doi:10.11648/j.ijcems.20210701.15

Hydroxychloroquine and Chloroquine Induced Cardiomyopathy: A Concise Review

Pramod Theetha Kariyanna, Andrew Doodnauth, Mrinali Shetty, Benjamin Ramalanjaona, Naseem Hossain, Yuvraj Singh Chowdhury, Nimrah Hossain, Apoorva Jayarangaiah, Adam Budzikowski

Published in International Journal of Clinical and Experimental Medical Sciences (Volume 7, Issue 1)

Received: 14 May 2020 Accepted: 9 September 2020 Published: 9 February 2021

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Abstract

Hydroxychloroquine and Chloroquine are commonly used for the treatment of malaria and autoimmune conditions. Most recently, hydroxychloroquine has been implicated in the treatment armamentarium of Severe acute respiratory syndrome (SARS) caused by SARS-associated coronavirus-2. A rare, underreported side effect of hydroxychloroquine and chloroquine is cardiotoxicity. The cardiomyopathy occurs as a result of inhibition of lysosomal enzymes causing lysosomal dysfunction and intra-cellular accumulation of metabolic byproducts in the myocardium, leading to hypertrophy with or without restrictive physiology and resultant conduction abnormalities. Based on our review of 57 reported cases of hydroxychloroquine or chloroquine induced cardiomyopathy, dyspnea was the most common associated symptom. The most common rhythms seen on EKG were as follows: complete heart block (18.75%), right bundle branch block (RBBB) (18.75%). The most common findings on echocardiography were left ventricular hypertrophy (LVH) (54%), systolic dysfunction (48%) and diastolic dysfunction (32%). A definitive diagnosis is established by endomyocardial biopsy which demonstrates the presence of curvilinear inclusion bodies. The outcome following cessation of the offending agent ranges from complete reversal in 45% of the cases to continued progression with need for cardiac transplantation or even death in 17.5% of the cases.

Published in	International Journal of Clinical and Experimental Medical Sciences (Volume 7, Issue 1)
DOI	10.11648/j.ijcems.20210701.15
Page(s)	31-36
Creative Commons	This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.
Copyright	Copyright © The Author(s), 2024. Published by Science Publishing Group

Keywords

Drug-induced Cardiomyopathy, Hydroxychloroquine, Chloroquine, Biventricular Hypertrophy, Non-ischemic Cardiomyopathy, Complete Heart Block, Inclusion Bodies

References

[1]	Manohar S, Tripathi M, Rawat DS. 4-aminoquinoline based molecular hybrids as antimalarials: an overview. Current topics in medicinal chemistry. 2014; 14 (14): 1706-1733.
[2]	Smolen JS, Landewe R, Breedveld FC, et al. EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2013 update. Annals of the rheumatic diseases. 2014; 73 (3): 492-509.
[3]	Fanouriakis A, Kostopoulou M, Alunno A, et al. 2019 update of the EULAR recommendations for the management of systemic lupus erythematosus. Annals of the rheumatic diseases. 2019; 78 (6): 736-745.
[4]	Gordon C, Amissah-Arthur MB, Gayed M, et al. The British Society for Rheumatology guideline for the management of systemic lupus erythematosus in adults. Rheumatology (Oxford, England). 2018; 57 (1): e1-e45.
[5]	Tektonidou MG, Andreoli L, Limper M, et al. EULAR recommendations for the management of antiphospholipid syndrome in adults. Annals of the rheumatic diseases. 2019; 78 (10): 1296-1304.
[6]	Vivino FB, Carsons SE, Foulks G, et al. New Treatment Guidelines for Sjögren's Disease. Rheum Dis Clin North Am. 2016; 42 (3): 531-551.
[7]	Liu D, Li X, Zhang Y, et al. Chloroquine and hydroxychloroquine are associated with reduced cardiovascular risk: a systematic review and meta-analysis. Drug Des Devel Ther. 2018; 12: 1685-1695.
[8]	Rempenault C, Combe B, Barnetche T, et al. Metabolic and cardiovascular benefits of hydroxychloroquine in patients with rheumatoid arthritis: a systematic review and meta-analysis. Annals of the rheumatic diseases. 2018; 77 (1): 98-103.
[9]	Ratliff NB, Estes ML, Myles JL, Shirey EK, McMahon JT. Diagnosis of chloroquine cardiomyopathy by endomyocardial biopsy. N Engl J Med. 1987; 316 (4): 191-193.
[10]	Iglesias Cubero G, Rodriguez Reguero JJ, Rojo Ortega JM. Restrictive cardiomyopathy caused by chloroquine. Br Heart J. 1993; 69 (5): 451-452.
[11]	Walsh DS, Farley MF, Beard JS, Sau P, Tesar J, James WD. Systemic lupus erythematosus: nephritis, dilated cardiomyopathy, and extensive cutaneous depigmentation responsive to hydroxychloroquine. J Am Acad Dermatol. 1995; 33 (5 Pt 1): 828-830.
[12]	August C, Holzhausen HJ, Schmoldt A, Pompecki R, Schroder S. Histological and ultrastructural findings in chloroquine-induced cardiomyopathy. J Mol Med (Berl). 1995; 73 (2): 73-77.
[13]	Baguet JP, Tremel F, Fabre M. Chloroquine cardiomyopathy with conduction disorders. Heart. 1999; 81 (2): 221-223.
[14]	Cervera A, Espinosa G, Font J, Ingelmo M. Cardiac toxicity secondary to long term treatment with chloroquine. Ann Rheum Dis. 2001; 60 (3): 301.
[15]	Roos JM, Aubry MC, Edwards WD. Chloroquine cardiotoxicity: clinicopathologic features in three patients and comparison with three patients with Fabry disease. Cardiovasc Pathol. 2002; 11 (5): 277-283.
[16]	Teixeira RA, Martinelli Filho M, Benvenuti LA, Costa R, Pedrosa AA, Nishioka SA. Cardiac damage from chronic use of chloroquine: a case report and review of the literature. Arq Bras Cardiol. 2002; 79 (1): 85-88.
[17]	Freihage JH, Patel NC, Jacobs WR, et al. Heart transplantation in a patient with chloroquine-induced cardiomyopathy. J Heart Lung Transplant. 2004; 23 (2): 252-255.
[18]	Nord JE, Shah PK, Rinaldi RZ, Weisman MH. Hydroxychloroquine cardiotoxicity in systemic lupus erythematosus: a report of 2 cases and review of the literature. Semin Arthritis Rheum. 2004; 33 (5): 336-351.
[19]	Keating RJ, Bhatia S, Amin S, Williams A, Sinak LJ, Edwards WD. Hydroxychloroquine-induced cardiotoxicity in a 39-year-old woman with systemic lupus erythematosus and systolic dysfunction. J Am Soc Echocardiogr. 2005; 18 (9): 981.
[20]	Naqvi TZ, Luthringer D, Marchevsky A, Saouf R, Gul K, Buchbinder NA. Chloroquine-induced cardiomyopathy-echocardiographic features. J Am Soc Echocardiogr. 2005; 18 (4): 383-387.
[21]	Reffelmann T, Naami A, Spuentrup E, Kuhl HP. Images in cardiovascular medicine. Contrast-enhanced magnetic resonance imaging of a patient with chloroquine-induced cardiomyopathy confirmed by endomyocardial biopsy. Circulation. 2006; 114 (8): e357-358.
[22]	Costedoat-Chalumeau N, Hulot JS, Amoura Z, et al. Cardiomyopathy related to antimalarial therapy with illustrative case report. Cardiology. 2007; 107 (2): 73-80.
[23]	Soong TR, Barouch LA, Champion HC, Wigley FM, Halushka MK. New clinical and ultrastructural findings in hydroxychloroquine-induced cardiomyopathy--a report of 2 cases. Hum Pathol. 2007; 38 (12): 1858-1863.
[24]	Cotroneo J, Sleik KM, Rene Rodriguez E, Klein AL. Hydroxychloroquine-induced restrictive cardiomyopathy. Eur J Echocardiogr. 2007; 8 (4): 247-251.
[25]	Fragasso G, Sanvito F, Baratto F, Martinenghi S, Doglioni C, Margonato A. Cardiotoxicity after low-dose chloroquine antimalarial therapy. Heart Vessels. 2009; 24 (5): 385-387.
[26]	Manohar VA, Moder KG, Edwards WD, Klarich K. Restrictive cardiomyopathy secondary to hydroxychloroquine therapy. J Rheumatol. 2009; 36 (2): 440-441.
[27]	Magnussen I, de Fine Olivarius B. Cardiomyopathy after chloroquine treatment. Acta Med Scand. 1977; 202 (5): 429-431.
[28]	Lee JH, Chung WB, Kang JH, et al. A case of chloroquine-induced cardiomyopathy that presented as sick sinus syndrome. Korean Circ J. 2010; 40 (11): 604-608.
[29]	Muthukrishnan P, Roukoz H, Grafton G, Jessurun J, Colvin-Adams M. Hydroxychloroquine-induced cardiomyopathy: a case report. Circ Heart Fail. 2011; 4 (2): e7-8.
[30]	Hartmann M, Meek IL, van Houwelingen GK, et al. Acute left ventricular failure in a patient with hydroxychloroquine-induced cardiomyopathy. Neth Heart J. 2011; 19 (11): 482-485.
[31]	Bae SM, Jung HO, Ihm SM, et al. Hydroxychloroquine-induced cardiomyopathy that presented as pulmonary hypertension: a newly noted complication. Cardiology. 2012; 123 (3): 197-200.
[32]	Azimian M, Gultekin SH, Hata JL, et al. Fatal antimalarial-induced cardiomyopathy: report of 2 cases. J Clin Rheumatol. 2012; 18 (7): 363-366.
[33]	Champion S, Malissin I, Cleophax C, et al. Chloroquine poisoning-associated inverted Tako-tsubo cardiomyopathy. Clin Toxicol (Phila). 2012; 50 (7): 721-722.
[34]	Tonnesmann E, Stroehmann I, Kandolf R, et al. Cardiomyopathy caused by longterm treatment with chloroquine: a rare disease, or a rare diagnosis? J Rheumatol. 2012; 39 (5): 1099-1103.
[35]	Frustaci A, Morgante E, Antuzzi D, Russo MA, Chimenti C. Inhibition of cardiomyocyte lysosomal activity in hydroxychloroquine cardiomyopathy. Int J Cardiol. 2012; 157 (1): 117-119.
[36]	Joyce E, Fabre A, Mahon N. Hydroxychloroquine cardiotoxicity presenting as a rapidly evolving biventricular cardiomyopathy: key diagnostic features and literature review. Eur Heart J Acute Cardiovasc Care. 2013; 2 (1): 77-83.
[37]	Vereckei A, Fazakas A, Balo T, Fekete B, Molnar MJ, Karadi I. Chloroquine cardiotoxicity mimicking connective tissue disease heart involvement. Immunopharmacol Immunotoxicol. 2013; 35 (2): 304-306.
[38]	Yogasundaram H, Putko BN, Tien J, et al. Hydroxychloroquine-induced cardiomyopathy: case report, pathophysiology, diagnosis, and treatment. Can J Cardiol. 2014; 30 (12): 1706-1715.
[39]	Lopez-Ruiz N, Uribe CE. Chloroquine cardiomyopathy: beyond ocular adverse effects. BMJ Case Rep. 2014; 2014.
[40]	Abdin A, Poss J, Kandolf R, Thiele H. Hydroxychloroquine-induced cardiomyopathy in a patient with limited cutaneous systemic sclerosis. Clin Res Cardiol. 2017; 106 (3): 234-236.
[41]	Tselios K, Gladman DD, Harvey P, et al. Hydroxychloroquine-Induced Cardiomyopathy in Systemic Lupus Erythematosus. J Clin Rheumatol. 2016; 22 (5): 287-288.
[42]	Sabato LA, Mendes LA, Cox ZL. Restrictive Cardiomyopathy Associated With Long-Term Use of Hydroxychloroquine for Systemic Lupus Erythematosus. J Pharm Pract. 2017; 30 (5): 571-575.
[43]	Chatre C, Filippi N, Roubille F, Pers YM. Heart Involvement in a Woman Treated with Hydroxychloroquine for Systemic Lupus Erythematosus Revealing Fabry Disease. J Rheumatol. 2016; 43 (5): 997-998.
[44]	Pavsic N, Mraz J, Strazar ZD, et al. Shunt reversal due to deterioration of chloroquine-induced cardiomyopathy in a patient with primary Sjogren syndrome. Int J Cardiol. 2016; 215: 145-146.
[45]	Di Girolamo F, Claver E, Olive M, Salazar-Mendiguchia J, Manito N, Cequier A. Dilated Cardiomyopathy and Hydroxychloroquine-induced Phospholipidosis: From Curvilinear Bodies to Clinical Suspicion. Rev Esp Cardiol (Engl Ed). 2018; 71 (6): 491-493.
[46]	Yogasundaram H, Hung W, Paterson ID, Sergi C, Oudit GY. Chloroquine-induced cardiomyopathy: a reversible cause of heart failure. ESC Heart Fail. 2018; 5 (3): 372-375.
[47]	Dogar MU, Shah NN, Ishtiaq S, et al. Hydroxychloroquine-induced restrictive cardiomyopathy: a case report. Postgrad Med J. 2018; 94 (1109): 185-186.
[48]	Tselios K, Deeb M, Gladman DD, et al. Antimalarial-induced Cardiomyopathy in Systemic Lupus Erythematosus: As Rare as Considered? J Rheumatol. 2019; 46 (4): 391-396.
[49]	Krafts K, Hempelmann E, Skórska-Stania A. From methylene blue to chloroquine: a brief review of the development of an antimalarial therapy. Parasitol Res. 2012; 111 (1): 1-6.
[50]	Hydroxychloroquine Sulfate Drug Usage Statistics, United States, 2007 - 2017. https://clincalc.com/DrugStats/Drugs/HydroxychloroquineSulfate. Accessed March 8th 2020, 2020.
[51]	Mackenzie AH. Pharmacologic actions of 4-aminoquinoline compounds. The American journal of medicine. 1983; 75 (1a): 5-10.
[52]	Michaelides M, Stover NB, Francis PJ, Weleber RG. Retinal toxicity associated with hydroxychloroquine and chloroquine: risk factors, screening, and progression despite cessation of therapy. Archives of ophthalmology (Chicago, Ill: 1960). 2011; 129 (1): 30-39.
[53]	Katz SJ, Russell AS. Re-evaluation of antimalarials in treating rheumatic diseases: re-appreciation and insights into new mechanisms of action. Current opinion in rheumatology. 2011; 23 (3): 278-281.
[54]	Siddiqui AK, Huberfeld SI, Weidenheim KM, Einberg KR, Efferen LS. Hydroxychloroquine-induced toxic myopathy causing respiratory failure. Chest. 2007; 131 (2): 588-590.
[55]	Stein M, Bell MJ, Ang LC. Hydroxychloroquine neuromyotoxicity. The Journal of rheumatology. 2000; 27 (12): 2927-2931.
[56]	Schrezenmeier E, Dorner T. Mechanisms of action of hydroxychloroquine and chloroquine: implications for rheumatology. Nature reviews Rheumatology. 2020; 16 (3): 155-166.
[57]	McAllister HA, Jr., Ferrans VJ, Hall RJ, Strickman NE, Bossart MI. Chloroquine-induced cardiomyopathy. Archives of pathology & laboratory medicine. 1987; 111 (10): 953-956.
[58]	Ferrans VJ, Hall RJ, McAllister HA, Jr. Images in Cardiovascular Medicine. Chloroquine-induced cardiomyopathy. Circulation. 1993; 88 (2): 785-786.
[59]	Boldrini R, Biselli R, Santorelli FM, Bosman C. Neuronal ceroid lipofuscinosis: an ultrastructural, genetic, and clinical study report. Ultrastructural pathology. 2001; 25 (1): 51-58.
[60]	SANGHVI LM, MATHUR BB. Electrocardiogram after Chloroquine and Emetine. Circulation. 1965; 32 (2): 281-289.
[61]	Oli JM, Ihenacho HN, Talwar RS. Chronic chloroquine toxicity and heart block: a report of two cases. East African medical journal. 1980; 57 (7): 505-507.
[62]	Ladipo GO, Essien EE, Andy JJ. Complete heart block in chronic chloroquine poisoning. International journal of cardiology. 1983; 4 (2): 198-200.
[63]	IHENACHO HNC, MAGULIKE E. CHLOROQUINE ABUSE AND HEART BLOCK IN AFRICANS. Australian and New Zealand Journal of Medicine. 1989; 19 (1): 17-21.
[64]	Ogola ES, Muita AK, Adala H. Chloroquine related complete heart block with blindness: case report. East African medical journal. 1992; 69 (1): 50-52.
[65]	Voskuyl AE. The heart and cardiovascular manifestations in rheumatoid arthritis. Rheumatology (Oxford, England). 2006; 45 Suppl 4: iv4-7.
[66]	Jain D, Halushka MK. Cardiac pathology of systemic lupus erythematosus. Journal of clinical pathology. 2009; 62 (7): 584-592.
[67]	Rewcastle NB, Humphrey JG. VACUOLAR MYOPATHY: CLINICAL, HISTOCHEMICAL, AND MICROSCOPIC STUDY. Archives of neurology. 1965; 12: 570-582.
[68]	Ramsey MS, Fine BS. Chloroquine toxicity in the human eye. Histopathologic observations by electron microscopy. American journal of ophthalmology. 1972; 73 (2): 229-235.
[69]	Tegner R, Tome FM, Godeau P, Lhermitte F, Fardeau M. Morphological study of peripheral nerve changes induced by chloroquine treatment. Acta neuropathologica. 1988; 75 (3): 253-260.
[70]	Tonnesmann E, Kandolf R, Lewalter T. Chloroquine cardiomyopathy - a review of the literature. Immunopharmacology and immunotoxicology. 2013; 35 (3): 434-442.

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APA Style

Pramod Theetha Kariyanna, Andrew Doodnauth, Mrinali Shetty, Benjamin Ramalanjaona, Naseem Hossain, et al. (2021). Hydroxychloroquine and Chloroquine Induced Cardiomyopathy: A Concise Review. International Journal of Clinical and Experimental Medical Sciences, 7(1), 31-36. https://doi.org/10.11648/j.ijcems.20210701.15

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ACS Style

Pramod Theetha Kariyanna; Andrew Doodnauth; Mrinali Shetty; Benjamin Ramalanjaona; Naseem Hossain, et al. Hydroxychloroquine and Chloroquine Induced Cardiomyopathy: A Concise Review. Int. J. Clin. Exp. Med. Sci. 2021, 7(1), 31-36. doi: 10.11648/j.ijcems.20210701.15

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AMA Style

Pramod Theetha Kariyanna, Andrew Doodnauth, Mrinali Shetty, Benjamin Ramalanjaona, Naseem Hossain, et al. Hydroxychloroquine and Chloroquine Induced Cardiomyopathy: A Concise Review. Int J Clin Exp Med Sci. 2021;7(1):31-36. doi: 10.11648/j.ijcems.20210701.15

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@article{10.11648/j.ijcems.20210701.15,
  author = {Pramod Theetha Kariyanna and Andrew Doodnauth and Mrinali Shetty and Benjamin Ramalanjaona and Naseem Hossain and Yuvraj Singh Chowdhury and Nimrah Hossain and Apoorva Jayarangaiah and Adam Budzikowski},
  title = {Hydroxychloroquine and Chloroquine Induced Cardiomyopathy: A Concise Review},
  journal = {International Journal of Clinical and Experimental Medical Sciences},
  volume = {7},
  number = {1},
  pages = {31-36},
  doi = {10.11648/j.ijcems.20210701.15},
  url = {https://doi.org/10.11648/j.ijcems.20210701.15},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ijcems.20210701.15},
  abstract = {Hydroxychloroquine and Chloroquine are commonly used for the treatment of malaria and autoimmune conditions. Most recently, hydroxychloroquine has been implicated in the treatment armamentarium of Severe acute respiratory syndrome (SARS) caused by SARS-associated coronavirus-2. A rare, underreported side effect of hydroxychloroquine and chloroquine is cardiotoxicity. The cardiomyopathy occurs as a result of inhibition of lysosomal enzymes causing lysosomal dysfunction and intra-cellular accumulation of metabolic byproducts in the myocardium, leading to hypertrophy with or without restrictive physiology and resultant conduction abnormalities. Based on our review of 57 reported cases of hydroxychloroquine or chloroquine induced cardiomyopathy, dyspnea was the most common associated symptom. The most common rhythms seen on EKG were as follows: complete heart block (18.75%), right bundle branch block (RBBB) (18.75%). The most common findings on echocardiography were left ventricular hypertrophy (LVH) (54%), systolic dysfunction (48%) and diastolic dysfunction (32%). A definitive diagnosis is established by endomyocardial biopsy which demonstrates the presence of curvilinear inclusion bodies. The outcome following cessation of the offending agent ranges from complete reversal in 45% of the cases to continued progression with need for cardiac transplantation or even death in 17.5% of the cases.},
 year = {2021}
}

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TY  - JOUR
T1  - Hydroxychloroquine and Chloroquine Induced Cardiomyopathy: A Concise Review
AU  - Pramod Theetha Kariyanna
AU  - Andrew Doodnauth
AU  - Mrinali Shetty
AU  - Benjamin Ramalanjaona
AU  - Naseem Hossain
AU  - Yuvraj Singh Chowdhury
AU  - Nimrah Hossain
AU  - Apoorva Jayarangaiah
AU  - Adam Budzikowski
Y1  - 2021/02/09
PY  - 2021
N1  - https://doi.org/10.11648/j.ijcems.20210701.15
DO  - 10.11648/j.ijcems.20210701.15
T2  - International Journal of Clinical and Experimental Medical Sciences
JF  - International Journal of Clinical and Experimental Medical Sciences
JO  - International Journal of Clinical and Experimental Medical Sciences
SP  - 31
EP  - 36
PB  - Science Publishing Group
SN  - 2469-8032
UR  - https://doi.org/10.11648/j.ijcems.20210701.15
AB  - Hydroxychloroquine and Chloroquine are commonly used for the treatment of malaria and autoimmune conditions. Most recently, hydroxychloroquine has been implicated in the treatment armamentarium of Severe acute respiratory syndrome (SARS) caused by SARS-associated coronavirus-2. A rare, underreported side effect of hydroxychloroquine and chloroquine is cardiotoxicity. The cardiomyopathy occurs as a result of inhibition of lysosomal enzymes causing lysosomal dysfunction and intra-cellular accumulation of metabolic byproducts in the myocardium, leading to hypertrophy with or without restrictive physiology and resultant conduction abnormalities. Based on our review of 57 reported cases of hydroxychloroquine or chloroquine induced cardiomyopathy, dyspnea was the most common associated symptom. The most common rhythms seen on EKG were as follows: complete heart block (18.75%), right bundle branch block (RBBB) (18.75%). The most common findings on echocardiography were left ventricular hypertrophy (LVH) (54%), systolic dysfunction (48%) and diastolic dysfunction (32%). A definitive diagnosis is established by endomyocardial biopsy which demonstrates the presence of curvilinear inclusion bodies. The outcome following cessation of the offending agent ranges from complete reversal in 45% of the cases to continued progression with need for cardiac transplantation or even death in 17.5% of the cases.
VL  - 7
IS  - 1
ER  -

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Author Information

Pramod Theetha Kariyanna

Division of Cardiovascular Medicine, Department of Medicine, SUNY Downstate Medical Sciences University, Brooklyn, New York, USA
Andrew Doodnauth

Division of Cardiovascular Medicine, Department of Medicine, SUNY Downstate Medical Sciences University, Brooklyn, New York, USA
Mrinali Shetty

Division of Cardiology, Department of Internal Medicine, Northshore University Health System, University of Chicago, Chicago, USA
Benjamin Ramalanjaona

Division of Cardiovascular Medicine, Department of Medicine, SUNY Downstate Medical Sciences University, Brooklyn, New York, USA
Naseem Hossain

Division of Cardiovascular Medicine, Department of Medicine, SUNY Downstate Medical Sciences University, Brooklyn, New York, USA
Yuvraj Singh Chowdhury

Division of Cardiovascular Medicine, Department of Medicine, SUNY Downstate Medical Sciences University, Brooklyn, New York, USA
Nimrah Hossain

Department of Internal Medicine, New York Presbyterian-Brooklyn Methodist Hospital, Brooklyn, New York, USA
Apoorva Jayarangaiah

Department of Internal Medicine, Albert Einstein College of medicine/Jacobi Medical Center, Bronx, N. Y., USA
Adam Budzikowski

Division of Cardiovascular Medicine, Department of Medicine, SUNY Downstate Medical Sciences University, Brooklyn, New York, USA

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APA Style

Pramod Theetha Kariyanna, Andrew Doodnauth, Mrinali Shetty, Benjamin Ramalanjaona, Naseem Hossain, et al. (2021). Hydroxychloroquine and Chloroquine Induced Cardiomyopathy: A Concise Review. International Journal of Clinical and Experimental Medical Sciences, 7(1), 31-36. https://doi.org/10.11648/j.ijcems.20210701.15

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ACS Style

Pramod Theetha Kariyanna; Andrew Doodnauth; Mrinali Shetty; Benjamin Ramalanjaona; Naseem Hossain, et al. Hydroxychloroquine and Chloroquine Induced Cardiomyopathy: A Concise Review. Int. J. Clin. Exp. Med. Sci. 2021, 7(1), 31-36. doi: 10.11648/j.ijcems.20210701.15

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AMA Style

Pramod Theetha Kariyanna, Andrew Doodnauth, Mrinali Shetty, Benjamin Ramalanjaona, Naseem Hossain, et al. Hydroxychloroquine and Chloroquine Induced Cardiomyopathy: A Concise Review. Int J Clin Exp Med Sci. 2021;7(1):31-36. doi: 10.11648/j.ijcems.20210701.15

Copy | Download

@article{10.11648/j.ijcems.20210701.15,
  author = {Pramod Theetha Kariyanna and Andrew Doodnauth and Mrinali Shetty and Benjamin Ramalanjaona and Naseem Hossain and Yuvraj Singh Chowdhury and Nimrah Hossain and Apoorva Jayarangaiah and Adam Budzikowski},
  title = {Hydroxychloroquine and Chloroquine Induced Cardiomyopathy: A Concise Review},
  journal = {International Journal of Clinical and Experimental Medical Sciences},
  volume = {7},
  number = {1},
  pages = {31-36},
  doi = {10.11648/j.ijcems.20210701.15},
  url = {https://doi.org/10.11648/j.ijcems.20210701.15},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ijcems.20210701.15},
  abstract = {Hydroxychloroquine and Chloroquine are commonly used for the treatment of malaria and autoimmune conditions. Most recently, hydroxychloroquine has been implicated in the treatment armamentarium of Severe acute respiratory syndrome (SARS) caused by SARS-associated coronavirus-2. A rare, underreported side effect of hydroxychloroquine and chloroquine is cardiotoxicity. The cardiomyopathy occurs as a result of inhibition of lysosomal enzymes causing lysosomal dysfunction and intra-cellular accumulation of metabolic byproducts in the myocardium, leading to hypertrophy with or without restrictive physiology and resultant conduction abnormalities. Based on our review of 57 reported cases of hydroxychloroquine or chloroquine induced cardiomyopathy, dyspnea was the most common associated symptom. The most common rhythms seen on EKG were as follows: complete heart block (18.75%), right bundle branch block (RBBB) (18.75%). The most common findings on echocardiography were left ventricular hypertrophy (LVH) (54%), systolic dysfunction (48%) and diastolic dysfunction (32%). A definitive diagnosis is established by endomyocardial biopsy which demonstrates the presence of curvilinear inclusion bodies. The outcome following cessation of the offending agent ranges from complete reversal in 45% of the cases to continued progression with need for cardiac transplantation or even death in 17.5% of the cases.},
 year = {2021}
}

Copy | Download

TY  - JOUR
T1  - Hydroxychloroquine and Chloroquine Induced Cardiomyopathy: A Concise Review
AU  - Pramod Theetha Kariyanna
AU  - Andrew Doodnauth
AU  - Mrinali Shetty
AU  - Benjamin Ramalanjaona
AU  - Naseem Hossain
AU  - Yuvraj Singh Chowdhury
AU  - Nimrah Hossain
AU  - Apoorva Jayarangaiah
AU  - Adam Budzikowski
Y1  - 2021/02/09
PY  - 2021
N1  - https://doi.org/10.11648/j.ijcems.20210701.15
DO  - 10.11648/j.ijcems.20210701.15
T2  - International Journal of Clinical and Experimental Medical Sciences
JF  - International Journal of Clinical and Experimental Medical Sciences
JO  - International Journal of Clinical and Experimental Medical Sciences
SP  - 31
EP  - 36
PB  - Science Publishing Group
SN  - 2469-8032
UR  - https://doi.org/10.11648/j.ijcems.20210701.15
AB  - Hydroxychloroquine and Chloroquine are commonly used for the treatment of malaria and autoimmune conditions. Most recently, hydroxychloroquine has been implicated in the treatment armamentarium of Severe acute respiratory syndrome (SARS) caused by SARS-associated coronavirus-2. A rare, underreported side effect of hydroxychloroquine and chloroquine is cardiotoxicity. The cardiomyopathy occurs as a result of inhibition of lysosomal enzymes causing lysosomal dysfunction and intra-cellular accumulation of metabolic byproducts in the myocardium, leading to hypertrophy with or without restrictive physiology and resultant conduction abnormalities. Based on our review of 57 reported cases of hydroxychloroquine or chloroquine induced cardiomyopathy, dyspnea was the most common associated symptom. The most common rhythms seen on EKG were as follows: complete heart block (18.75%), right bundle branch block (RBBB) (18.75%). The most common findings on echocardiography were left ventricular hypertrophy (LVH) (54%), systolic dysfunction (48%) and diastolic dysfunction (32%). A definitive diagnosis is established by endomyocardial biopsy which demonstrates the presence of curvilinear inclusion bodies. The outcome following cessation of the offending agent ranges from complete reversal in 45% of the cases to continued progression with need for cardiac transplantation or even death in 17.5% of the cases.
VL  - 7
IS  - 1
ER  -

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